Troops risk undetected, serious brain injury/ Even mild injuries to brain add up

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Troops risk undetected brain injury Updated 6/6/2006 11:52 PM ET By

Gregg Zoroya, USA TODAY

 

Thousands of troops in Iraq and Afghanistan may be risking permanent brain

damage by returning to combat with relatively minor but undiagnosed concussions,

often caused by bomb blasts, military researchers say.

 

Doctors say they are only now understanding the scope of the problem.

Researchers screening returning soldiers and Marines at four military bases

found that about 10% suffered at least a minor brain injury during combat. About

20% of troops in front-line infantry units suffered such injuries.

 

The injuries frequently go undiagnosed because troops have no visible wounds

or may not know they suffered a concussion, doctors say. Medics and field

doctors often aren't aware of what happened during fighting.

 

FROM MILD TO SEVERE: Injuries to brain adding up (added below)

 

More than 500,000 soldiers and Marines have served in or near Iraq and

Afghanistan since Sept. 11, 2001, sometimes more than once.

 

" This blast group is going to be potentially huge, " says Angela Drake, a

neuropsychologist with the Defense and Veterans Brain Injury Center, a research

arm of the Department of Veterans Affairs and the Pentagon. " We're looking at

thousands of potential patients. "

 

Military doctors describe brain injuries as a signature wound of these wars.

That's because advances in body armor save soldiers who might have died in

previous conflicts, but blast waves from roadside bombs can cause brain damage.

 

U.S. troops in Iraq are exposed to hundreds of bombings each month. " We've

seen patients who have had three deployments and have had some (head) injury on

every single one, " Drake says.

 

The damage from multiple concussions can be irreversible. " Repeated

concussions can be quite serious and even lethal, " says Air Force Maj. Gerald

Grant, a neurosurgeon who treated troops in Iraq.

 

The Brain Injury Center is urging the military to track the number of

concussions troops suffer. A handful of military bases use the screening

procedures developed by the center, but the Pentagon has declined to mandate the

survey.

 

Pentagon health official Michael Kilpatrick questioned the accuracy of the

screening and whether soldiers even remember information they're asked for:

" Most people, when they get knocked out, don't really know it. "

 

Military researchers, however, say the two-question survey has proved highly

accurate.

 

" I think they're afraid, " Drake says of the Pentagon's decision not to screen

for concussions. " The sheer numbers are overwhelming. This is a worrisome thing.

It's like opening a can of worms. "

 

The Pentagon is developing a simple mental exam that medics can use on troops

who may have suffered a brain injury. If the test shows evidence of a mild

concussion, a servicemember could be kept from combat until the injury heals.

Kilpatrick says this test could be used in Iraq within a few months.

http://www.usatoday.com/news/health/2006-06-06-brain-damage-main_x.htm

 

WHAT IS A CONCUSSION? Concussions occur when a blow to the

head jars the brain, triggering disorientation and sometimes more severe

effects. Although often written-off as minor nuisances, the injuries can have

serious, long-term consequences.

 

Symptoms after a blow to the head: Possible loss of consciousness, trouble

remembering things before and after the injury, confusion, dizziness, vertigo,

lightheadedness, blurred or double vision and ringing in the ears.

 

Different levels of severity: Physicians determine a concussion's severity by

reviewing the length of time a person is disoriented, length of unconsciousness

and amount of memory loss.

 

• Mild: Characterized by confusion and no loss of consciousness. Symptoms

disappear in less than 15 minutes.

• Moderate: Confusion that lasts more than 15 minutes and loss of consciousness

for less than five minutes.

• Severe: Loss of consciousness for more than five minutes. Symptoms, including

amnesia, persist for more than 24 hours.

 

 

Research by Shawn Brouwer, USA TODAY

 

Even mild injuries to brain add up Updated 6/6/2006 11:52 PM ET

 

By Gregg Zoroya, USA TODAY

 

After a land mine exploded under his armored vehicle last October in Barwana,

Iraq, Marine Sgt. Devon Bradley remembers a deafening noise and a flash. Then

nothing.

 

Seconds later, when he came to, Bradley grabbed his weapon and went back into

the fight. He led his team for the next two months in efforts to clear

insurgents from Barwana.

 

" We're hard dogs, and I kept pushing to be with my Marines, " says Bradley, 29,

who was on his third combat tour.

 

But something was wrong. In the weeks that followed the blast, he began

forgetting what other Marines had just told him. He struggled to handle more

than one task at once. Taste and smell disappeared. Worst of all, so did the

name of his soon-to-be-born daughter, Addison. Bradley says he had to dig

through letters from home to remember it.

 

He was eventually flown to a battlefield hospital where he was diagnosed with

a concussion — his second in the Iraq war and the third of his life. Bradley

learned that what he thought was post-nasal drip was actually leaking spinal

fluid.

 

By January, he was back at Camp Pendleton in California. Doctors told him his

brain may never fully recover, and his career in the Marine Corps is in doubt

 

After more than three years of war in Iraq, where bombs are the biggest threat

to U.S. troops, military doctors are seeing a growing number of brain injuries

among soldiers and Marines caught too close to a blast. The vast majority are

mild concussions that cannot be detected even with a CT scan or MRI.

 

In danger of permanent damage

 

Mild brain injuries can heal in days or even months. Additional concussions

can cause permanent damage. " This is a real issue, and people are ... taking it

very seriously, " says Deborah Warden, director of the Defense and Veterans Brain

Injury Center, a research arm of the Department of Veterans Affairs and the

Pentagon.

 

RISK: Troops suffering from undetected injuries (above)

 

The ramifications are broad. How do field surgeons and medics diagnose a wound

they can't see? What can be done when soldiers and Marines try to shake off the

blast effects, unaware of the concussion, and keep fighting? Should the Pentagon

keep tabs on how many concussions each servicemember suffers? And if so, how

many concussions is too many before someone is kept from combat?

 

" We're not at the Star Trek point where we can run a phaser over everybody and

determine their exact problem. Closed-head injuries are very hard to assess, "

says Michael Kilpatrick, deputy director of deployment health support for the

Pentagon.

 

The number of concussions keeps rising. Almost 30% of the patients admitted to

Walter Reed Army Medical Center in Washington, D.C., have brain injuries.

 

Doctors fear that thousands of others go undiagnosed. A two-question survey

developed by the Brain Injury Center shows that about 10% of troops returning

from Iraq and Afghanistan suffered a concussion during their combat tour.

 

About half still had symptoms that could be related to a concussion, including

slowed thinking, headaches, memory loss, sleep disturbance, attention and

concentration deficits, and irritability, says Air Force Lt. Col. Michael

Jaffee, a neurologist with the center. More than 500,000 soldiers and Marines

have served in combat since Sept. 11, 2001, many more than once.

 

During the screening, troops are first asked whether they were hurt in a

blast, fall or vehicle accident. Then they are asked whether they felt dazed,

were confused or saw " stars " afterward; do not remember what happened; or lost

consciousness. If any of those symptoms occurred, the servicemember probably

suffered a concussion, Warden says.

 

The screening offers a way to document brain injuries. The ability to count

the injuries also has prompted disagreement about what to do with the

information.

 

Warden urges that all returning troops be screened to build a concussion

database. But today the screenings — which began about two years ago — are done

at only a few military installations, including the Marine Corps' Camp Pendleton

and the Army's Fort Carson in Colorado, Fort Bragg in North Carolina and Fort

Irwin in California.

 

Kilpatrick, the Pentagon official, questions the accuracy of the screening.

" Multiple head injuries can lead to permanent brain damage that is irreversible,

and you want to avoid that, " he says. " But we don't have any criteria today that

if you get X number of concussions, that you can't serve anymore. "

 

Neurologist Jaffee says settling on one number that applies to every

servicemember is impossible because of the many variables, among them the size

of the blast and the severity of the concussion. That's why concussion histories

and better battlefield diagnoses are needed, he says.

 

Developing diagnostics

 

The military is developing ways to diagnose with tests that examine short-term

memory, reaction time and attention deficit, key indicators of concussion. The

tests are similar to those used on athletes who suffer head injuries. The Brain

Injury Center is also creating a short exam Kilpatrick says could soon be

introduced into war zones.

 

Computerized testing programs, used to monitor combat troops at Fort Bragg,

are being tested for the battlefield. In April, the military approved a

battlefield study by Air Force neurologist Gerald Grant for developing an online

test for troops in Iraq.

 

During preliminary field tests, about 60 soldiers and Marines exposed to

blasts were examined. In one case, a 25-year-old man caught near a roadside bomb

struggled to process information and quickly answer questions. Two weeks later,

before returning to combat, he continued to score below average or worse in both

areas.

 

A second man, age 37, took the exam 15 hours after a rocket exploded on the

other side of the wall from where he was standing guard. He showed

attention-deficit problems and scored poorly in short-term memory.

 

" We need a field test to be able to practically assess the safety of sending

people back to duty, " Grant says.

 

Marine Sgt. Bradley says he suffered his first concussion in high school

sports. His second concussion came during a rocket-propelled grenade attack in

Iraq. After his third brain injury, doctors told him a fourth could kill him.

 

He and his wife, Megan, have three young daughters and say they face an

uncertain future leaving the military. Bradley still experiences dizzy spells,

bad headaches and back problems.

 

" Most of them are pretty much every day, " he says. " I have one right now. "

http://www.usatoday.com/news/health/2006-06-06-brain-damage_x.htm

 

 

 

" Respect means listening until everyone has been heard and understood, only

then is there a possibility of " Balance and Harmony " the goal of Indian

Spirituality. " Dave Chief, Grandfather of Red Dog